Some Mainers with severe forms of mental illness could face the loss of services, unless the Legislature comes up with about $4.6 million to pay for them in the budget year that starts July 1. Mental health advocates told the Health and Human Services Committee today that the state is obligated under a court-ordered consent decree to provide these case management services. But as Patty Wight reports, it's unclear just who is ultimately responsible to find and allocate that money.

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The so-called AMHI Consent Decree was born out of a class action lawsuit against the state in the late 1980s. That's when poor conditions at the Augusta Mental Health Institute, now known as the Riverview Psychiatric Center, contributed to the deaths of 10 residents.

The Consent Decree, which the state signed to settle that suit, spells out what the Department of Health and Human Services is supposed to do to ensure it provides quality mental health care.

"Among other things, it requires the state to offer in the community a menu of mental health services," says former Maine Supreme Judicial Court Chief Justice Daniel Wathen (left), the court-appointed special master of the decree. It's his job to make sure the state is fulfilling its obligations.

And Wathen says the state is falling short when it comes to those community mental health services, because the budget for fiscal year 2015 is missing the $4.6 million required to provide case management services for those with severe mental illness who are not covered under MaineCare.

Wathen, who appeared before the Legislature's Health and Human Services Committee to testify, says currently there are are more than 160 people waiting for a long time to get help.

"The overall average is around 40 days. But hidden within that 40-day average, there are people waiting for more than a year," he says. "And there are many, many people who are waiting four, five, and six months."

Case management is important, says Shalom House Clinical Director Ed Blanchard, because case managers are the gateway to other services. "We sometimes call them the hub of the wheel - the person that helps connect and communicate with all the other providers a client might be utilizing," he says.

Without a case manager, says Blanchard, some of these clients can fall through the cracks of the system.

Department of Health and Human Services Commissioner Mary Mayhew also appeared before the committee. She told Democratic Rep. Richard Farnsworth that she's asked both the budget-writing staff in the department, and the Legislature's Appropriations Committee, to allocate the funding for case management services.

"No response to why that was not included, other than that it would not be included," Mayhew said.

"That's disappointing," Farnsworth said, "because this is a very important service that needs to be funded in order to make sure that these people are reasonably successful in the rest of their lives."

But just where that funding will come from is the million dollar - or rather the $4.6 million dollar question, to which committee members had no ready answers.

The issue will likely be passed over to the Appropriations Committee to decide if and where the funds can be found and allocated.
Photo: Patty Wight